Improvement Of Microcirculation Research Articles

Results of the impact of antiproteinase hemosorbent on the dynamics of clinical and laboratory indicators in children with generalized peritonitis

Introduction. Despite the undoubted success of modern medicine, peritonitis in children remains not only a surgical, but also a general pathological problem, the relevance of which does not decrease. The use of efferent therapy methods, in particular hemosorption, imitating the natural mechanisms of detoxification of the body, are promising in the complex therapy of children with peritonitis. Aim. The aim of the study was to establish the effectiveness of the antiproteinase hemosorbent „Hemo-proteazsorb” in the complex intensive care of children with generalized peritonitis. Material and methods. A prospective randomized study of 60 children with generalized peritonitis was conducted. In the main group, there were 30 patients who underwent hemosorption in complex intensive care, and the comparison group also included 30 patients who underwent traditional treatment. The examined groups were comparable in terms of the nature of the pathology and the severity of the condition. Results. During hemoperfusion, a significant increase in blood saturation was established from 95.1 (93.2; 97.1)% to 97.3 (95.5; 98.7)%, with an improvement in oxygen transport (ctO2, mmol/l) from 6.9 (6.4; 7.9) to 8.8 (1.5; 9.7) and a decrease in lactate level (mmol/l) from 1.7 (1.5;2.1) to 1.1 (0.9;1.3), which indicates normalization of blood oxygenation and improvement of microcirculation. After 24 hours, there was a significant decrease in the amount of points on the pSOFA scale, from 4.5 (3.0; 6.0) to 0.5 (0; 2.0), p < 0.001, normalization of body temperature, restoration of intestinal function was noted in 15 (50.0% CI: 32.1-67.9) children, which indicates a decrease in multiple organ dysfunction and improvement of the condition. When compared in the second group, the studied indicators changed much more slowly. Conclusions. The data obtained as a result of the study on the positive dynamics of clinical and laboratory parameters prove the high effectiveness of the use of the Belarusian hemosorbent ?Hemo-proteazsorb? in the complex of intensive care of generalized peritonitis.

Exposure to low output power laser with transcatheter intracerebral photobiomodulation therapy reduces mental and cognitive disorders and dementia in Alzheimer's disease

AbstractBackgroundTranscatheter Intracerebral Photobiomodulation Therapy (PBMT) using low output power laser is a promising area in AD treatment. The method is aimed at stimulating angiogenesis, restoring cerebral microcirculation, stimulating metabolic processes and ATP metabolism in neuronal mitochondria, stimulating neurogenesis and regenerating cerebral tissues.MethodThe treatment was performed for 93 patients suffering from various AD stages with dementia, cognitive and mental disorders aged 34‐80 (average age 67.5), men ‐ 32 (34.40%), women ‐ 61 (65.59%). The examination included: CDR determination, MMSE testing, CT, MRI with calculation of temporal lobe atrophy degree and determination of dementia stage using the Tomography Dementia Rating scale (TDR), cerebral scintigraphy (SG), rheoencephalography (REG), cerebral MUGA. Test Group: 48 (51.61%) patients underwent transcatheter intracerebral Photobiomodulation Therapy (PBMT) using a helium‐neon laser. According to atrophy and dementia degree, cognitive and mental disorders severity, the patients were divided: preclinical AD stage (TDR‐0) ‐ 4 (8.33%); early AD stage (TDR‐1) ‐ 16 (33.33%); medium AD stage (TDR‐2) ‐ 21 (43.76%); severe AD stage (TDR‐3) ‐ 7 (14.58%) patients. Control Group: 45 (48.39%) patients underwent conservative treatment (Memantine 5‐20mg or Rivastigmine 3‐12 mg daily). According to atrophy degree, the severity of dementia, cognitive and mental disorders, the patients were divided: preclinical AD stage (TDR‐0) ‐ 6 (13.33%); early AD stage (TDR‐1) ‐ 13 (28.89%); medium AD stage (TDR‐2) ‐ 15 (33.34%); severe AD stage (TDR‐3) ‐ 11 (24.44%) patients.ResultAn early follow‐up period of 6‐12 months. Test Group: all 48 (100%) patients showed improvement in cerebral microcirculation and signs of cerebral temporal lobes volume increase, which indicates neurogenesis and cerebral regenerative changes. The process was accompanied by clinical condition improvement, dementia decline, cognitive and mental functions restoration. Control Group: during the treatment, there was no stable improvement in the patients’ condition but a tendency to further increase in cerebral involutive changes, which was accompanied by dementia growth, cognitive and mental impairment.ConclusionTranscatheter intracerebral PBMT is a promising, effective AD treatment. It diminishes dementia, cognitive and mental disorders, and allows improving the quality of patients’ life and restoring their daily activity.

The Effect of Aqua-trainings are in Fresh Water in Patients with Hypertension on the Microcirculation

Walking in water (Aquatic Physiotherapy) is a simple, reproducible and affordable method. Warm pool water reduces peripheral vascular resistance. Purpose of the study was to assess the effect of dosed physical activity in a fresh water on the microcirculation of patients with arterial hypertension (AH) when applied externally. Materials and methods. The study included 14 subjects (7 men, 7 women) aged 18 to 70, with AH stage I. The patients were administered aqua training course in the form of walking in a fresh water for the 30 minutes duration, the course of treatment included 10 procedures, the water temperature in the pool was 30–32C. Before and after the end of the intervention, several parameters were monitored, including the assessment of microcirculation using laser Doppler flowmetry. Results: In patients receiving aqua training in a fresh water, there was a significant decrease of arterio-venular bypass grafting by 25.0%from the initial (Wilcoxon T-test = 310.0; p = 0.004) and an increase in the muscle component of microcirculation regulation (Wilcoxon T-test = 399.0; p <0.05), which indicates an improvement in microcirculation under the influence of aqua training. The optimal duration of training in fresh water was found to be equal to five days, after which the indicators characterizing microcirculation remain at the plateau level, without significantly changing. Significantly more often, the positive effect of aqua training was achieved in the group of patients with microcirculation disorders of the type of venous stasis (χ2 = 10.6; p <0.001). Conclusion. Laser Doppler flowmetry screening may be useful method to select patients with AH in a greatest need of aquatic training.

Abstract 14228: Pericytes Within a Pulmonary Neurovascular Unit in Covid-19-elicited Pathologic Changes

A pericyte-centered hypothesis suggests that embolisms occurring within microvasculature of a neurovascular unit can result in either parenchymal hemorrhage or intravascular congestion. Dysfunctional microvascular pericytes are featured depending on their location in the neurovascular unit. I extend the hypothesis by proposing a concept of pulmonary neurovascular unit (pNVU). In simulating pathophysiology in pulmonary embolisms, acute high-altitude illness and COVID-19, an existing local regulation of microvascular blood flow is believable. This control balances blood flow with oxygen supply to maintain physiological blood oxygen saturation level. We have reported a working module for the neurovascular unit in the sexually dimorphic nucleus of the preoptic area. Pericytes, labeled with alpha-smooth muscle actin immunoreactivity, are significantly denser within the microvasculature of the neurovascular unit in males, signifying their biological functions or potential pathophysiological role in diseases. Noticeably, an illustration provides an explanation of how malfunction of microvascular pericytes causes pulmonary focal hemorrhage, edema or microvascular congestion and thrombi [Fig. 1]. A bypass existing in the pNVU would autonomically deviate blood flow from COVID-19-affected pNVU to other healthy pNVU. Consequentially, systematically applied medicines including chloroquine and/or hydroxychloroquine became valueless due to low concentration of the medicine in the COVID-19-affected regions. Alternatively, a preventive, early antiviral therapy may be efficacious because dysfunctional blood-air exchange precedents and malfunction of pulmonary microcirculation follows. While testing the hypothesis with experimental evidence is urgently needed, supporting therapy aimed at improvement of microcirculation or rebuilding of microvascular pericytes’ physiological function may be recommended during the COVID pandemic.

Abstract 16282: The Development of the New Treatment for Distressed Microvascular Dysfunction in Porcine Dilated Cardiomyopathy Model Using Induced Pluripotent Stem Cell Derived Cardiomyocyte Sheet

Introduction: The progression of dilated cardiomyopathy (DCM) mainly involves genetic mutations or ischemia at the cellular level, leading to microvascular dysfunction associated with cell death, interstitial fibrosis, and high wall stress. Radical treatment of DCM requires how to ameliorate its microcirculation and integrate cardiomyocytes created ex vivo into recipient myocardium. Hypothesis: The induced pluripotent stem cell derived cardiomyocyte sheets (iPS-sheet) has therapeutic potential by the improvement of microcirculation in a porcine DCM model. Methods: The iPS-sheets were generated from clinical grade human iPS cells. A DCM model was created by tachycardia pacing, and iPS-sheet was transplanted with immunosuppressive agents 1 month after the initiation of the pacing. We compared the therapeutic efficacy functionally and pathologically between the iPS-sheet transplant group (iPS-group) and the sham group after 1 month of transplantation. Results: On echocardiography, the iPS group showed a significant improvement in contractility compared to the sham group (LVEF 4 weeks after transplantation iPS vs. sham 49.0±6.5% vs. 36.4±3.3%, p<0.05, Figure A). Pressure-volume loop analysis revealed that a significant decrease in left ventricular end diastolic pressure and an improvement in end-systolic pressure-volume relationship in the iPS group (Figure B). Ammonia PET showed improvement in myocardial blood flow at both rest and stress in iPS group (Figure C). Histological analysis revealed that the density of CD31-positive capillaries in transplanted area was significantly greater in the iPS group than the sham group. Immunostaining revealed iPS-sheet were detected on the epicardium of the distressed myocardium (Figure D). Conclusions: The iPS sheet showed engraftment in distressed myocardium, leading to amelioration in cardiac function through improving microcirculation with angiogenesis in porcine DCM model.

The effect of blood transfusion on sublingual microcirculation in critically ill patients: A scoping review.

To investigate the effects of red blood cell (RBC) transfusion on sublingual microcirculation in critically ill patients. Systematic strategy was conducted to search studies that measured sublingual microcirculation before and after transfusion in critically ill patients. This review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Scoping Review Extension. The literature search yielded 114 articles. A total of 11 studies met the inclusion criteria. Observational evidence showed diffusive capacity of the microcirculation significantly improved in intraoperative and anemic hematologic patients after transfusion, while the convective parameters significantly improved in traumatic patients. RBC transfusion improved both diffusive and convective microcirculatory parameters in hypovolemic hemorrhagic shock patients. Most of the studies enrolled septic patients showed no microcirculatory improvements after transfusion. The positive effects of the leukoreduction were insufficiently supported. The effects of the storage time of the RBCs were not conclusive. The majority of the evidence supported a negative correlation between baseline proportion of perfused vessels (PPV) and changes in PPV. This scoping review has catalogued evidence that RBC transfusion differently improves sublingual microcirculation in different populations. The existing evidence is not sufficient to conclude the effects of the leukoreduction and storage time of RBCs.

Optimizing remote ischemic conditioning (RIC) of cutaneous microcirculation in humans: Number of cycles and duration of acute effects

<h2>Summary</h2><h3>Objective</h3> Non-invasive Remote Ischemic Conditioning (RIC) offers an approach to reduce tissue damage in various organs/tissues. Besides attenuation of Ischemia-Reperfusion injury (I/R), beneficial effects on cutaneous microcirculation of free microsurgical flaps have been reported. Given the recency of this technique, there are considerable gaps in the current understanding of its mechanism of action. As a result, clinical transfer of RIC is prolongated in several fields. We aimed to optimize the RIC protocol by examination of different RIC-cycle numbers and its effect on changes of cutaneous microcirculation and duration. <h3>Methods</h3> 80 subjects were divided into groups (1, 3, 5, 7 RIC cycles). RIC was applied via an inflatable tourniquet. Cutaneous microcirculation was continuously assessed at the contralateral anterior lateral thigh utilizing a ©O2C-device continuously. <h3>Results</h3> RIC caused significant and sustained changes in microcirculation. Four hours after completion of RIC, a maximum increase of +80.8% (CI 1.395–2.221) in blood flow and +23.5% (CI 1.098–1.372) in tissue oxygen saturation was measured (three-cycle group). A higher number of applied cycles was accompanied with significant higher mean pain. <h3>Conclusion</h3> Acute improvement of cutaneous microcirculation due to RIC lasted for at least 4 h after completion of the RIC-protocol. Dose-dependent effects of RIC are likely. With regard to the increase in pain, we recommend a RIC protocol of 3 cycles for future clinical application.

Study of the effects of the principle of low-volume infusion therapy

Objective. To study the effects of low-volume infusion therapy on the pathogenetic elimination of endogenous intoxication in a patient with coronary heart disease.&#x0D; Materials and methods. The study included 30 patients diagnosed with COVID-19. The age of the patients was 45-65 years. All patients underwent generally accepted clinical laboratory and instrumental examinations. Rheosorbilact 200 ml intravenous was prescribed to all patients for the purpose of low-volume infusion therapy to reduce metabolic disorders, reduce the amount of free radicals and weaken inflammatory reactions, eliminate endogenous intoxication. The drug contains potassium chloride, calcium contains magnesium chloride, sodium lactate, sodium chloride and sorbitol.&#x0D; Results and discussion. The drug was positively received by patients during treatment and no side effects were observed. A “mild” effect on the pH of the blood was observed during the determination of Rheosorbilact. In addition, lactate has been shown to have a positive effect on cardiac function, liver and kidney detoxification function. The positive effect of Rheosorbilact on the functional state of the endothelial layer of microvascular vessels should be noted. As is known, the endothelial layer, which determines the motility of the vascular wall, has anti-inflammatory, antiplatelet, antiproliferative activity. Therefore, improvement of endothelial function under the influence of Rheosorbilact has been observed to increase the stability of hemovascular homeostasis and to maintain a stable level of adequate tissue perfusion in the examined patients. The unconditional advantage of the drug is the improvement of hemorrhagic parameters, as well as prophylactic antithrombotic effect. In elderly patients with ischemic heart disease, a 30 % decrease in platelet aggregation activity was observed during the administration of Rheosorbilact in combination with drugs for complex treatment. One of the positive effects of the drug was the improvement of rheological properties and microcirculation of the blood. In particular, a decrease in blood viscosity from 1.35±0.02 to 1.25±0.03 and a 25 % decrease in the erythrocyte aggregation index were observed in elderly patients.&#x0D; Conclusions. Thus, according to the results of the presented study, Rheosorbilact can be prescribed for the treatment of endogenous intoxication for small-volume infusion in patients with COVID-19 diagnosed with cardiovascular diseases. A positive effect on the size was observed.

High-Dose Vitamin D Supplementation Improves Microcirculation and Reduces Inflammation in Diabetic Neuropathy Patients.

We assessed the effect of different doses of vitamin D supplementation on microcirculation, signs and symptoms of peripheral neuropathy and inflammatory markers in patients with type 2 diabetes (T2DM). Sixty-seven patients with T2DM and peripheral neuropathy (34 females) were randomized into two treatment groups: Cholecalciferol 5000 IU and 40,000 IU once/week orally for 24 weeks. Severity of neuropathy (NSS, NDS scores, visual analogue scale), cutaneous microcirculation (MC) parameters and inflammatory markers (ILs, CRP, TNFα) were assessed before and after treatment. Vitamin D deficiency/insufficiency was detected in 78% of the 62 completed subjects. Following treatment with cholecalciferol 40,000 IU/week, a significant decrease in neuropathy severity (NSS, p = 0.001; NDS, p = 0.001; VAS, p = 0.001) and improvement of cutaneous MC were observed (p < 0.05). Also, we found a decrease in IL-6 level (2.5 pg/mL vs. 0.6 pg/mL, p < 0.001) and an increase in IL-10 level (2.5 pg/mL vs. 4.5 pg/mL, p < 0.001) after 24 weeks of vitamin D supplementation in this group. No changes were detected in the cholecalciferol 5000 IU/week group. High-dose cholecalciferol supplementation of 40,000 IU/week for 24 weeks was associated with improvement in clinical manifestation, cutaneous microcirculation and inflammatory markers in patients with T2DM and peripheral neuropathy.

Early Sequential Microcirculation Assessment In Shocked Patients as a Predictor of Outcome: A Prospective Observational Cohort Study.

A dysfunctional microcirculation is universal in shock and is often dissociated from global hemodynamic parameters. Persistent microcirculatory derangements reflect ongoing tissue hypoperfusion and organ injury. The initial microcirculatory dysfunction and subsequent resolution could potentially guide therapy and predict outcomes. We evaluated the microcirculation early in a heterogenous shocked population. Microcirculatory resolution was correlated with measures of tissue perfusion and global hemodynamics. The relationship between the microcirculation over 24 h and outcome were evaluated. We prospectively recruited patients with all forms of shock, based on global hemodynamics and evidence of organ hypoperfusion. A 30-bed adult intensive care unit (ICU). Eighty-two shocked patients. Following the diagnosis of shock, patients underwent a sublingual microcirculation examination using Sidestream Dark Field Imaging. The median age of patients was 66 years old (interquartile range [IQR] 54-71), with an Acute Physiology and Chronic Health Evaluation II of 27 (IQR 20-32). Microcirculatory parameters included Percentage Perfused Vessels (PPV), De Backer Score, and a heterogeneity index in patients with septic shock, according to the second consensus guidelines Additional parameters collected: temperature, heart rate and arterial pressure, cumulative fluid balance, and vasopressor use. Arterial blood samples were taken at the time of microcirculatory assessments, providing HCO3, lactate concentrations, PaO2, and PaCO2 measurements. A statistically significant improvement in PPV and the heterogeneity index was demonstrated. This improvement was mirrored by biomarkers of perfusion; however, the global hemodynamic parameter changes were not significantly different over the 24-h period. The early microcirculatory improvement was not predictive of an improvement in acute kidney injury, length of stay, ICU, or hospital mortality. Early sequential evaluation of the microcirculation in shocked patients, demonstrated statistically significant improvement in the PPV and microvascular heterogeneity with standard care. These improvements were mirrored by biomarkers of organ perfusion; however, the changes in global hemodynamics were not as pronounced in this early phase. Early improvement in the microcirculation did not predict clinical outcome.

Новые возможности применения гиалуронидазы при хроническом простатите

The use of hyaluronidase contributes to improvement in microcirculation, destruction of biofilms and reducing of congestion in patients with chronic prostatitis. Based on this mechanism, the use Longidaza for the diagnosis of latent bacterial prostatitis was suggested. To evaluate diagnostic and treatment capabilities of the long-acting enzyme preparation Longidaza (rectal suppositories with an activity of 3000 IU), prescribed to patients with chronic prostatitis in routine clinical practice. A total of 39 men with chronic prostatitis of categories II and IIIa were included in open, prospective, non-interventional, comparative, single-center study. A microbiological study of expressed prostate secretion (EPS) was performed three times, at baseline, after using two suppositories Longidaza 3000 IU and after 7 weeks of therapy. From the 1st to the 10th suppository, Longidaza was used every 48 hours, then, from the 11th to the 20th suppository, it was prescribed every 72 hours. The isolation of the pathogen was an indication for the antibiotic therapy. The treatment outcome was evaluated by using NIH-CPSI scale and laboratory and microbiological analysis of EPS. Diagnostic stage. Initially, pathogens were isolated in 27 (69.2%) patients. The number of leukocytes in EPS averaged 25.9+/-2.3. The use of two suppositories Longidaza increased the number of patients with isolated pathogens to 33 (82%). In 7 out 12 patients with an initial diagnosis of abacterial prostatitis, the use of two suppositories of Longidaza contributed to isolation of the pathogen in EPS (58.3%). The number of leukocytes in the EPS after enzymatic provocation increased by 50.2%. Treatment stage. The number of patients with isolated pathogens decreased from 33 to 7 (17.9%). The pain intensity decreased on average to 2.2+/-0.4 points, and in 27 (69.2%) men dysuria resolved. The quality of life significantly improved up to 1.3+/-0.2 points. The total score on NIH-CPSI scale decreased on average from 17.3+/-1.9 to 3.9+/-0.3 (p<0.05). An increased number of white blood cells in EPS was seen only in 5 (12.8%) men. In many cases, bacterial prostatitis remains undiagnosed. Rectal suppositories Longidaza can be recommended for the diagnosis of the latent bacterial chronic prostatitis, since this drug contributes to detection of pathogen and inflammation.

Ammonia — new therapeutic target for chronic liver diseases

Objective : to study some mechanisms of progression of chronic liver diseases in patients with initial stage of liver fi brosis and the possibility of their correction. Materials and methods : a total of 69 young patients with chronic liver diseases with initial stage 0–2 fi brosis (26 patients with chronic viral hepatitis C, 43 patients with nonalcoholic steatohepatitis) were examined. Ammonia levels were determined in peripheral blood by the method of single photometry reveals on the analyzer PocketChem BA, ArcRay (Japan), for the integral evaluation of intrahepatic blood fl ow disorders was used polyhepatography (PHG) is a non — invasive method.The intensity of the activity of the stellate cells of the liver (HSCs) was determined according to the expression of SMA-alpha in a liver biopsy sample. In terms of correction of hyperammoniemia and portohepatic hemodynamics disorders in our study used hepatoprotector with hypoammoniemic eff ect ornithine (L-ornithine-L-aspartate). Results : ammonia levels in HCV patients and NASH patients was signifi cantly higher than in the control group, the level of hyperammoniemia prevailed in patients with NASH than HCV patients. Portohepatic hemodynamics disorders were detected in all patients, while the peculiarities of these disorders, depending on the etiology of hepatitis. These hemodynamic disorders were accompanied by signs of activation of HSCs. In the liver tissue we revealed expression of SMA-alpha in HSCs, indicating that the signs of activation of these cells. Efficiencyanalysis of the eff ectiveness of Ornithine showed a signifi cant reduction of ammonia in the blood and improvement in intrahepatic blood fl ow in patients with diff erent types of portohepatic hemodynamics disorders on the background of treatment. Conclusion : in HCV and NASH patients, already at the initial stage sofl iver fi brosis, hyperammoniemia was detected (with HCV it was signifi cantly higher), activation of HSCs, which leads to impaired portohepatic hemodynamics in these patients. The use of a hepatoprotector with the hypoammoniemic eff ect Ornithine leads to a decrease of blood ammonia and an improvement of hepatic microcirculation, which allows expanding the possibilities of the pathogenetic treatment of chronic hepatitis for decrease of fi brogenesis.

Application of laser speckle contrast imaging technology to researches on acupuncture and microcirculation

The therapeutic effect of acupuncture is often closely related to the improvement of microcirculation. Acupuncture stimulation can adjust pathophysiological changes of microcirculation in the human body through multiple ways, multiple links and multiple levels, healing disorders at last. Laser speckle contrast imaging (LSCI), an emerging technology, can be used to study the effect of acupuncture on microcirculation. In this paper, retrieving the related literature published in recent years, we found that LSCI technology has already been applied to the following aspects 1) acupoint-viscera and microcirculation, 2) stimulation-induced transmission of sensations along the meridian and microcirculation, 3) non-meridians or non-acupoints and microcirculation, 4) specific acupoints and microcirculation, as well as 5) different acupuncture needle manipulations and microcirculation. However, most of the studies focused on animal experiments and healthy subjects, observing microcirculatory effects under normal physiological conditions, and the sample size of participants was smaller. In the future, we highly recommend that increasing the sample size and further studying the local microcirculation are necessary in the pathological state of diseases.

Assessment of sublingual microcirculation in critically ill patients: consensus and debate.

The main concern in shock and resuscitation is whether the microcirculation can carry adequate oxygen to the tissues and remove waste. Identification of an intact coherence between macro- and microcirculation during states of shock and resuscitation shows a functioning regulatory mechanism. However, loss of hemodynamic coherence between the macro and microcirculation can be encountered frequently in sepsis, cardiogenic shock, or any hemodynamically compromised patient. This loss of hemodynamic coherence results in an improvement in macrohemodynamic parameters following resuscitation without a parallel improvement in microcirculation resulting in tissue hypoxia and tissue compromise. Hand-held vital microscopes (HVMs) can visualize the microcirculation and help to diagnose the nature of microcirculatory shock. Although treatment with the sole aim of recruiting the microcirculation is as yet not realized, interventions can be tailored to the needs of the patient while monitoring sublingual microcirculation. With the help of the newly introduced software, called MicroTools, we believe sublingual microcirculation monitoring and diagnosis will be an essential point-of-care tool in managing shock patients.

Physiotherapy delivery systems-clinical and microbiological effectiveness in the treatment of chronic periodontitis

Relevance . Currently, the symbiotic microflora of the oral cavity plays an increasing role in the occurrence of periodontitis. Frequent use of modern medications for the treatment of patients with chronic generalized periodontitis is not the most effective therapy. One of the reasons for the low effectiveness of treatment can be considered long-term use of antibacterial drugs that lead to the development of dysbiosis in the oral cavity and immune imbalance. In order to improve the quality of periodontal treatment, dentists successfully use physical therapy. It is known that the diode laser has a high therapeutic efficiency, its use leads to a rapid subsiding of acute inflammatory phenomena, stimulation of reparative (recovery) processes, improvement of tissue microcirculation, normalization of the General immune system, and increased resistance (stability) of the body. Ozone generators used for dental treatment have a beneficial effect on periodontal tissues. Therapeutic ozone has: immunostimulating, bactericidal, fungicidal, anti-inflammatory, detoxifying and other properties. Purpose . The goal is to study the antibacterial effect of physiotherapy methods with local delivery of exposure agents. Materials and methods . We examined 80 patients with chronic generalized periodontitis of moderate severity, who, depending on the physiotherapy method used in the complex treatment of periodontitis, were divided into 2 groups of 40 people each: the first group used the Picasso led laser, and the second group used the Ozonedta device with combined local exposure to darsonvalization and ozone. The microbiological composition of periodontal pockets was determined before and after physical therapy. To isolate the aerobic microflora, we used the method of sector crops according to Gold (1965) with the calculation of the number of microorganisms in the obtained material. Anaerobes were identified by PCR using the «Multident» kit. The clinical effectiveness of the studied physiotherapy methods was evaluated 12 months after two courses of treatment (once every 6 months) using index indicators that characterize the state of periodontal tissues (PMA, CPI, Green-Vermillion, PPP, PDI, and the degree of gum recession). Results . After exposure to the Picasso diode laser, the number of aerobic microorganisms sown decreases, but not significantly. While the number of aerobic microorganisms significantly decreased after exposure to the «Ozonedta» device (P ≤ 0.001). The titer of the anaerobic microflora studied after exposure to the «Picasso» diode laser on the periodontal pocket changed in the direction of reducing the content of microorganisms by an average of 2 times, and after treatment with the ozone generator «Ozone DTA Generator» in the second group decreased by an average of 4.8 times. After 12 months of maintenance therapy, all clinical indices decreased significantly in both groups, especially the PMA index in the group where the «Ozonedta» device was used. Conclusion . Physiotherapy methods performed using the Picasso diode laser and the «Ozonedta» device for the treatment of periodontitis allow to obtain an antibacterial effect by non-drug local delivery of exposure agents in patients with chronic generalized periodontitis and significantly reduce the signs of inflammation in the periodontal tissues.

Anxiety Disorder and Alternating Bilateral Ptosis as the First Symptoms of Diabetes: A Case Report

Introduction: Long-term diabetes may cause oculomotor nerve palsy and anxiety disorder. Diabetic oculomotor nerve palsy is usually accompanied by diplopia, ptosis and eye movement disorders. The oculomotor nerve is often separated into superior and inferior divisions; diabetic third cranial nerve palsy may affect either division in isolation. However, anxiety disorder and alternating bilateral ptosis as the first symptoms of diabetes are extremely rare. Case Presentation: This case report describes a 63-year-old female patient who was admitted to the hospital for anxiety disorder with bilateral alternating ptosis. The patient had no diplopia or other new focal neurological symptoms. A neurological examination revealed left upper eyelid ptosis; other findings were negative. Except for hyperglycemia (13.96 mmol/L) and glycated hemoglobin (7.9%), laboratory tests showed no other abnormalities. The patient eventually recovered in a short time after a comprehensive treatment, including effective blood glucose control, microcirculation improvement and anxiety management. Conclusion: The upper eyelid droop caused by long-term diabetes may result in anxiety disorder. A comprehensive treatment may be considered for the patients admitted to the hospital for diabetes and its vascular neuropathy.

Optical Coherence Tomography with Angiography in the Analysis of Vitrectomy Effectiveness in Patients with Vitreomacular Traction Syndrome

Micro incision vitrectomy surgery with removal of epiretinal and internal limiting membranes is used for treating various forms of vitreomacular traction syndrome.Objective: to study the condition of retinal microcirculation using the OCTA method in the patients with traction maculopathy and macular ruptures before and after vitrectomy.Patients and Methods. The study included 160 patients, of which 55 had epiretinal fibrosis (Treatment 1), 60 had macular ruptures (Treatment 2), and 45 with no ophthalmic pathology (Control). Treatment 2 group included two subgroups: 2a — patients with large-diameter ruptures (over 800 μm) subject to inverted internal limiting membrane flap technique (n = 12), and 2b — patients with 430–800 μm ruptures subject to rapprochement of the rupture edges with a platelet mass technique. All patients underwent conventional ophthalmology examinations and optical coherence tomography angiography (OCTA) using Sirrus HD-OCT 5000, Carl Zeiss, Germany.Results. In the postoperative period, there was an improvement in retinal microcirculation in the Treatment 1 patients, and the values of both perfusion and vascular densities increased. A month later, an additional improvement of these indicators was recorded against the background of a decrease in retinal thickness and restoration of the vitreoretinal interface configuration. In the early postoperative period, Treatment 2 patients showed significant difference in the capillary density of the superficial vascular complex from the control group. A month later, the density of blood vessels in the Treatment 2 patients achieved control group values. Despite an immediate increase in perfusion measurements after surgical treatment, their values in a month were still lower than in the control group.Conclusions. In the patients with epiretinal membrane and macular ruptures, a statistically significant decrease in both vascular and perfusion densities of the surface capillary complex was revealed by OCTA. The effects of vitreoretinal surgery performed on Treatment 1 and 2 patients with macula traction pathology included increased visual acuity, decreased retinal thickness, and restoration of the proper vitreoretinal profile. Based on OCTA results, we discovered a gradual increase in vascular density of the macula in Treatment 1 and 2 patients after surgical treatment of VMT syndrome. Retinal perfusion in the macular region of Treatment 1 patients achieved the values of the control group within a month, while in Treatment 2 patients they increased, but remained lower than in control group. OCTA is a highly informative method for the diagnostics and monitoring of the eye posterior segment condition in the patients with VMT syndrome.

Effect of Xihuang Pill on microcirculation in DMBA combined estrogen and progesterone induced breast precancerous lesions rats

Objective: To observe the effect of Xihuang Pill on microcirculation in 7,12-dimethylbenzoanthracene (DMBA) combined estrogen and progesterone induced breast precancerous lesions rats. Method: DMBA combined estrogen and progesterone were used to establish the model of breast precancerous lesions for 10 weeks in SD rats, then the low, medium and high dose Xihuang Pill (0.27, 0.55, 1.37g·kg−1) was given intragastric administration, and tamoxifen (4 mg·kg−1) was given intragastric administration as a positive control after the breast precancerous lesions models established successfully. The breast microcirculation was measured by laser Doppler flowmetry (LDF) in rats after 4 weeks of Xihuang Pill and tamoxifen intragastric administration. Result: Compared with the normal control group, the microcirculation perfusion of breast in the disease model group decreased significantly (P < 0.05). Compared with the disease model group, the breast microcirculation perfusion in each dose group of Xihuang Pill increased significantly (P < 0.05). Conclusion: The mechanism of Xihuang Pill in the treatment of breast precancerous lesions may be related to the improvement of breast microcirculation.

Characteristics and clinical value of sublingual microcirculation in children with sepsis

Objective To investigate the characteristics of sublingual microcirculation in children with sepsis, and to explore the clinical value of sublingual microcirculation in the early diagnosis, therapeutic effect evaluation of sepsis in children. Methods Children with sepsis and community acquired pneumonia(CAP) admitted in our hospital from December 2018 to December 2019 were included in the study, which was divided into sepsis group and control group(CAP group). In the sepsis group, large circulation indexes and sublingual microcirculation indexes were collected at 0, 6, and 24 hours after admission.Sublingual microcirculation indexes were collected by bypass dark field imaging.In the control group, large circulation indexes were collected after admission, and sublingual microcirculation indexes were collected during tracheal endoscopic examination after sedation.De Backer score(DBs), hetergeneity index(HI), hetergeneity index small(HIs), proportion of pefusedvessels(PPV), proportion of pefused small vessels(PPVs), total of vessel density(TVD), pefused vessel density(PVD), pefused small vessel density(PVDs)were selected as the evaluation index of sublingual microcirculation.The changes of macrocirculation and microcirculation indexes in the two groups were compared, and the correlation between age and microcirculation indexes in the control group was analyzed. Results A total of 71 children, including 10 sepsis cases and 61 CAP cases, were collected.Among the 61 children with CAP, 9 children (2-48 months) in the same age range as the sepsis group were divided into control group A, and the indicators between the two groups were analyzed.Compared with control group A, PPV and PPVs were lower and DBs, HI, HIs, TVD were higher in the sepsis group at 0 hours(P 0.05). At 24 hours, HI, PPV and PPVs improved, no difference was found compared with the control group A(P 0.05). The age of the control group had a moderate negative correlation with HI, and a weak negative correlation with HIs(r=-0.420, P=0.001; r=-0.387, P=0.002). Conclusion HI, HIs, PPV and PPVs are sensitive indexes of microcirculation disorder in children with sepsis.Fluid resuscitation therapy can improve the indexes of sublingual microcirculation in children with sepsis, but the improvement of sublingual microcirculation in children with sepsis is later than the recovery of macro circulation.HI and HIs are negatively correlated with month age in children with CAP. Key words: Sepsis; Sublingual microcirculation; Sidestream dark field; Community acquired pneumonia; Children

Early norepinephrine use in septic shock.

As vascular tone depression is a hallmark of septic shock, administration of norepinephrine is logical in this setting. In this article, we provide and develop the following arguments for an early use of norepinephrine-the recommended first-line vasopressor-in septic shock: (I) prevention of prolonged severe hypotension, (II) increase in cardiac output through an increase in cardiac preload and/or contractility, (III) improvement of microcirculation and tissue oxygenation, (IV) prevention of fluid overload, and (V) improvement of outcome. Presence of a low diastolic arterial pressure as a marker of depressed vascular tone can be used as a trigger to initiate norepinephrine urgently.